نوع مقاله : مقاله مروری

نویسندگان

1 گروه داروسازی بالینی، دانشکده داروسازی، دانشگاه علوم پزشکی شیراز.

2 دانشجوی دکترای تخصصی داروسازی بالینی، گروه داروسازی بالینی دانشکده داروسازی، دانشگاه علوم پزشکی شیراز، شیراز، ایران

چکیده

فیبریلاسیون دهلیزی، یکی از شایع‏ترین آریتمی‏ها در بالین است که شانس بروز حوادث ایسکمیک (ischemic) و عوارض متعاقب آن از جمله نارسایی قلبی، سکته قلبی، دمانس و مرگ ناگهانی قلبی را بالا برده و به طور کلی با افزایش میزان از کار افتادگی و مرگ و میر در بیماران همراه است. کاهش میزان بروز سکته و حوادث ایسکمیک در این بیماران، با استفاده از داروهای ضد انعقاد خوراکی صورت می‏گیرد. این داروها به دو دسته کلی شامل آنتاگونیست خوراکی ویتامین K (وارفارین) و داروهای ضد انعقاد خوراکی غیر آنتاگونیست ویتامین K هستند که دسته دوم خود به دو زیر شاخه‏ی مهار کننده‏های مستقیم فاکتور انعقادی 10 فعال (Xa) و مهارکننده‏های مستقیم فاکتور انعقادی 2فعال (IIa) تقسیم می‏شود. هر دو دسته اصلی دارویی دارای کارایی و ایمنی اثبات شده در پیشگیری از بروز حوادث ایسکمیک در بیماران فیبریلاسیون دهلیزی هستند. اما، امروزه با افزایش میزان شیوع و بروز بیماری، انتخاب داروی ضد انعقاد خوراکی مناسب، با توجه به شرایط و عوامل تهدید کننده خاص در هر بیمار، بعضا می‏تواند چالش برانگیز باشد. این مقاله مروری، با هدف بررسی کارآیی و ایمنی داروهای ضد انعقاد خوراکی در بیماران مبتلا به فیبریلاسیون دهلیزی در شرایط پیچیده، گردآوری شده است. در نهایت مروری نیز بر آنتی‏دوت‏های جدید ترکیبات ضد انعقاد خوراکی غیر آنتاگونیست ویتامین K، برای مهار خون‏ریزی در شرایط مسمومیت و یا نیاز بیمار به جراحی‏های اورژانسی، انجام شده است.

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